Ch 29 Flashcards
Technique for mechanically circulating and oxygenating blood outside the body
Extracorporeal circulation or cardiopulmonary bypass
Surgical techniques that improved the delivery of oxygenated blood to the myocardium for clients who have coronary artery disease (CAD)
Myocardial revascularization
Surgery improves myocardial oxygenation by bypassing or detouring around the occluded portion of one or more coronary arteries with a relocated blood vessel
Coronary artery bypass
A coronary artery bypass is performed when
SATA (3)
-The client has multiple coronary artery occlusions
-The anatomic location of the occlusion interferes with the safe insertion of a coronary artery catheter
-The heart cannot be repaired
Disadvantages of cardiopulmonary bypass
Necessity for anticoagulation
Risk for stroke, arrhythmias, and renal failure
Alternative harvesting vessels for grafting include the following SATA (4)
-the internal mammary and internal thoracic arteries in the chest
-the basilic and cephalic veins in the arm
-the radial artery in the arm
-the gastroepiploic artery from the stomach
Does not involve the use of a cardiopulmonary bypass machine. Surgeon keeps heart beating at slow rated (40) with drugs
Off pump coronary artery bypass (OPCAB)
Drugs used during OPCAB
Adenosine (Adenocard)
Esmolol (Brevibloc)
Opening adhesions in the valve cusps, which is done without direct visualization of the valve
Commissurotomy
Valve repair
Valvuloplasty
Repair of the fibrous ring that encircles the valve
Annuloplasty
Procedures that surgically tighten an incompetent valve
Valvuloplasty
Annuloplasty
Disadvantages of mechanic heart valves
Risk for thrombi and emboli
Anticoagulation necessary
Risk for bleeding
Types of heart valves
Mechanical
Allograft(homograft)
Compression of the heart with accumulating blood
Cardiac tamponade
Adults, heart transplantation is indicated for
Cardiomyopathy
End stage CAD
End stage HF
Newborns & infants, heart transplantation is indicated for
Several congenital cardiac defect
Performed only when other treatment modalities fail or are unavailable
Central venous pressure
Right atrial pressure
The pressure produced by venous blood in the right atrium
Most common artery used in placement of direct BP monitoring
Radial artery
Occurs within a few minutes of the transplant when the donor organ and recipient are extremely mismatched
Hyperacute rejection
Occurs from 1 week to 3 months after the transplant; almost all transplant recipients experience to some degree
Acute rejection
May occur anytime over the remaining lifetime of a recipient, causing varying degrees of damage to the donor heart
Chronic rejection
The transplanted heart beats faster than the clients natural heart (100-110) because the nerves that affect the HR have been severed
Cardiovascular disease
Resection and removal of the lining of an artery
Endarterectomy
Endarterectomy performed to remove obstructive atherosclerotic plaques from
Aorta
Carotid
Femoral
Popliteal arteries
When thrombi or emboli occlude a major vessel a __ is performed
Thromboectomy or embolectomy
Direct BP monitoring may be used in clients with
Severe and sustained hypertension or hypotension and during and after cardiac surgery
Retrograde pressure from the fluid on the left side of the heart at the end of left ventricular diastole
Pulmonary capillary wedge pressure
